POS0186 OBSTRUCTIVE SLEEP APNEA: A CONTRIBUTING FACTOR IN GOUT?
Authors: P. Khandwala, D. Desai, M. Sen
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> As per World Health Organization, 7.44 million cases of gout were estimated globally in 2017 (incidence, 0.097%), with a prevalence of 41.22 million cases (0.54%).<sup>[[1]]</sup> Obstructive sleep apnea (OSA) is a co-morbidity that has shared risk factors with gout as well as causes pathophysiological mechanisms causing hyperuricemia. The relationship remains contentious. There have been studies, mainly in the UK, which have shown 1.5 times increased risk of gout in patients with OSA <sup>[[2,3]]</sup>. While the study by Durme et al shows that the association disappears after statistical adjustment for BMI, renal function, heart failure, and use of diuretics.<sup>[[4]]</sup> Thus, it becomes vital to contribute to the existing literature to investigate this relationship further. <h3>Objectives</h3> The aim of the study is to understand the relationship between OSA and Gout. <h3>Methods</h3> TrinetX, a global federated research network that provides a dataset of electronic medical records from different healthcare organizations (HCOs), was utilized. Initial query was made to isolate patients who had a BMI greater than 30 and then 2 groups were made on the presence or absence of OSA. Further, propensity score matching (PSM) was carried out to match age, sex, race, chronic kidney disease, heart failure, and use of diuretics. Compare outcome analytic function was utilized to map the co-relation with Gout. <h3>Results</h3> A total of 3,541,566 patients who had a BMI&gt;30 were identified, out of which 817,638 (23.09%) patients had OSA. Patients in OSA group were older as compared to patients in non-OSA group (59.8 ± 14.3 years vs 54 ± 17.2 years). Females made up 50% of the OSA group while they were predominant (65%) in the non-OSA group. Caucasians were the predominant race, followed by African Americans. 7.19% of patients with OSA had Gout, while 2.84% without OSA had gout (p&lt;0.0001). The odds of having gout is 2.65 times higher in patients with OSA than patients without OSA (hazard ratio is 2.393, 95% confidence interval (CI) 2.367-2.419, p&lt;0.0001). After PSM, both groups had 801,526 patients. 6.93% patients with OSA had gout while 4.63% of patients without OSA had gout (p&lt;0.0001). Odds ratio =1.533, (95% CI 1.512 - 1.554, p&lt;0.0001) and hazard ratio was 1.404 (95% CI 1.386-1.423). <h3>Conclusion</h3> Our study demonstrated that there is a strong correlation between Gout and OSA. Hypoxia-induced hyperuricemia is the most widespread explanation.<sup>[[5]]</sup> However, there are many confounding factors that prompted us to carry out matching for demographics and, more importantly for chronic kidney disease, heart failure as well as the use of diuretics. Statistically significant odds ratio after matching attests to the fact that there is a robust correlation between gout and OSA. Limitation of this study was the lack of testing of this hypothesis on patients with BMI&lt;30. Prospective cohort studies are required to further test the strength of the relationship between OSA and Gout. <h3>References</h3> [1]Mattiuzzi C, Lippi G. Recent updates on worldwide gout epidemiology. Clin Rheumatol. 2020 Apr;39(4):1061-1063. doi: 10.1007/s10067-019-04868-9. Epub 2019 Dec 13. PMID: 31836936. [2]Zhang, Y., Peloquin, C.E., Dubreuil, M., Roddy, E., Lu, N., Neogi, T. and Choi, H.K. (2015), Sleep Apnea and the Risk of Incident Gout: A Population-Based, Body Mass Index–Matched Cohort Study. Arthritis &amp; Rheumatology, 67: 3298-3302 https://doi.org/10.1002/art.39330 [3]Blagojevic-Bucknall, M., Mallen, C., Muller, S., Hayward, R., West, S., Choi, H. and Roddy, E. (2019), The Risk of Gout Among Patients With Sleep Apnea: A Matched Cohort Study. Arthritis Rheumatol, 71: 154-160. https://doi.org/10.1002/art.40662 [4]van Durme, C., Spaetgens, B., Driessen, J. <i>et al.</i> Obstructive sleep apnea and the risk of gout: a population-based case-control study. <i>Arthritis Res Ther</i> 22, 92 (2020). https://doi.org/10.1186/s13075-020-02176-1 [5]Shi, T., Min, M., Sun, C. <i>et al.</i> A meta-analysis of the association between gout, serum uric acid level, and obstructive sleep apnea. <i>Sleep Breath</i><b>23</b>, 1047–1057 (2019). https://doi.org/10.1007/s11325-019-01827-1 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.